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Untangling the relationship between weightlifting and uterine prolapse

So the trajectory of this post has been an interesting one. When I started it a few days ago, I had planned to just let fly with the snark. I was piling up all of these one-liners, and I was going to unleash them upon you so you could glory in my wit and together we would all laugh together at the misguided fools who lacked our clarity of vision and who persisted in believing such dross.

But then for some reason, I guess because I wanted to make sure my snark was factual or some nerdy thing like that, I started doing some research. I read and read and read and before I knew it, I had spent a few hours, and then a couple of days immersed in research. I realized that maybe the ones expressing concern weren’t so misguided and that maybe they weren’t the fools in this equation.

What’s more, I started to see that, while I had lost my opportunity to make fun of what I saw as ignorance, I had stumbled upon something that’s actually rather important.

Let me back up. I started down this path after reading a blog post in which the author wrote about encouraging girls to move their own furniture. A commenter piped up to say that she wishes people wouldn’t encourage girls and women to lift heavy because in doing so, they are setting them down the path to develop uterine prolapse later in life.

Initially I was stunned into disbelief. I couldn’t believe I was actually seeing someone make the argument that women should not lift heavy things because it might cause their uteruses to fall out through their vaginas. I had thought that myth had fallen by the wayside decades ago, now supplanted by “weights will turn me into Ah-nuld” and “carbs will make me fat.” Yet here was this piece of fitness rhetoric that I’d thought had long since gone extinct, showing up in the comments of a blog post in 2013. Was this what it was like to be the first modern person to see a coelacanth?

Uterine prolapse, for those who are not aware, is defined by the Mayo Clinic as:

Uterine prolapse occurs when pelvic floor muscles and ligaments stretch and weaken, providing inadequate support for the uterus. The uterus then slips down into or protrudes out of the vagina.

The condition is often mild and goes unnoticed by the woman who has it, but sometimes it can lead to symptoms like discomfort during sex, repeated bladder infections, lower backaches or an uncomfortable feeling like sitting on a small ball.

Most of the sites I checked out listed the following as risk factors for uterine prolapse:

One or more vaginal births

Post-menopause/aging

Chronic cough or constipation

Pelvic tumors

Obesity (because of added weight on the pelvic organs)

Heavy lifting

Perhaps it is because of my interest in weight lifting and fitness, but immediately I wondered, what kind of heavy lifting? How often? What’s defined as “heavy”? Few of the popular medical resources out there went into much detail, beyond to just say “heavy lifting.”

I dug a bit deeper and while it seems like a relationship between uterine prolapse and heavy lifting (whatever that means) does in fact exist, it is not as simple as “lift heavy things and your uterus falls down.” Instead of that kind of direct causality, where you say x causes y, it seems like the situation is more informed by a variety of factors that intersect in a variety of ways with a variety of outcomes, which generally seems to the case when it comes to talking about health. I mean, we all know someone who has a relative who lived to be 98 while seemingly subsisting on nothing but Kools and bacon dipped in Crisco. Certain things may increase the likelihood that something will happen, but it’s not necessarily a forgone conclusion that it will happen.

What information I found indicated that women who were already mildly prolapsed or who had weak pelvic floor muscles might find their conditions worsened by heavy weight training, particularly if that weight training is not performed with proper form. Other proscriptions against weight training came in the context of post-operative healing, specifically advising women to avoid lifting heavy during that time. Squatting in particular was singled out as a particularly high-risk activity for post-operative women. However, I found another study that said a lack of physical activity was no real guarantee against prolapse and that in fact unconscious and uncontrollable things like coughing could present more of a risk to healing than something that is controlled, like lifting.

This information wasn’t readily available, though, and in fact, I had to dig around on sites like PubMed for this information. Only one popular medical site listed the “heavy lifting” risk factor with the qualifier “may contribute to uterine prolapse if pelvic muscles are already weakened.” Most people generally look at WebMD or the Mayo Clinic and leave it at that, so really, it’s not all that surprising to me that some would look up risk factors for uterine prolapse, see “heavy lifting” and then take that to mean women shouldn’t try to move heavy furniture or handle loaded barbells.

One of my best sources of information actually became blog comments and message boards, where female lifters who had actually gone through prolapse talked about their experiences.

[A]s a menopausal woman, (almost 53) having four children and a history of PFD, lifting weights and reasonable working out, did just the opposite for me. As I watched my midsection “cinch up” and had built some muscle, those issues slowly decreased until gone. Lifting weights and increasing my physical capacity only made ALL of me stronger including the parts that hold up my bladder, uterus..etc. “put them back where they belong”

Kegel exercises are a MUST but workin those lower abs and building them up works the whole pelvic floor too, so keep tensin that tum (like your tryin to fit into your skinny jeans) while doin your kegels and those muscles will be workin. Its totally possible to get rid of it without surgery, i did

About 10 years ago I had a 2nd degree prolapsed uterus, and I thought I was headed for a hysterectomy; every time I had sex I would bleed for a couple of days, and it always felt like my insides were falling out. (Because they were.) My family doctor didn’t offer any option besides a hysterectomy. Fortunately I ignored him and did some hunting around on the internet till I found this: Kegelmaster – Kegelmaster Original Official Website

This thing cured me within TWO WEEKS. It seems pretty weird when you go to the website, because the primary reasons women use it are for incontinence and enhanced sexual performance. Let’s face it, the thing looks like a sex toy. Prolapsed organs were way down on the list, they barely even mentioned it. But considering it cost less than a hundred bucks, I figured what did I have to lose? Anyway…here I am 10 years later with all my lady-parts still intact and no more prolapse. I only used it for about a year, and I’ve had no need to use it since, even with all the heavy lifting and jump-roping and other vigorous things I do.

But that’s not to say that the women who were urging caution were being alarmist. I thought this comment, from Di on Everyday Paleo, was useful in its specificity:

PLEASE urge women, particularly those who have given birth and those in peri-menopausal or menopausal years, to get clearance from a uro-gynecologist with extensive experience in prolapse issues before starting on CF or any heavy-lifting program.

Basically, after a lot of reading, these are the conclusions I came to:

That women who have given vaginal birth and/or who are older should get a medical workup before getting into a training program (which I think is considered standard medical advice for most people)

That pelvic floor exercises can help reduce the risk by strengthening the muscles and tissues that hold the organs in place

That weight lifting with proper form can reduce the risk of pelvic organ prolapse, among other injuries

That weight lifting can actually help with the condition by strengthening the core

Now, I am obviously not a medical researcher, an exercise physiologist, a gynecologist or anyone you could consider to be an expert in this field. I’m just a relentlessly curious person who happened to stumble upon a subject that lies at the intersection of two of my passions. I can say that I have some ideas about lifting weights and prolapse – because I do – but as far as whether I’m right? I have no idea, and I don’t feel qualified to act as though I do. I think my guidelines are sensible but the conjectures of a blogger are not the same as medical advice backed up by actual research.

Which brings me to my main point. As I read over all of this information – the popular medical sites, the blog posts and the message boards, and the studies – it occurred to me that there just isn’t that much information out there about this. I don’t mean there isn’t a lot of information about pelvic organ prolapse, because there is. Rather, there isn’t a lot of information out there as it specifically relates to women who lift heavy weights.

My completely non-professional suspicion got a bit of a boost when I found this abstract:

A narrative literature review was carried out to investigate the effects of occupation and recreational activity on the pathogenesis of pelvic organ prolapse. A marked paucity of literature relevant to the research question makes it difficult to draw firm conclusions. Further research is greatly needed to explore potentially preventable factors in this frequently occurring condition. The review reveals some evidence linking strenuous physical activity with pelvic organ prolapse but this is neither consistent nor adequately powered to reach any firm conclusions.

Considering that uterine prolapse is a common condition among women and that the risk factors include childbirth and aging, which are two risk factors that encompass pretty much every single one of us, I’d say that this is something that really needs to be researched more thoroughly. As much as I want to blow off the idea of strenuous physical activity causing women’s uteruses to fall out as an outdated holdover from the pre-Kathrine Switzer era of women’s sports, the fact is that there does seem to be something to the concerns. Biology can be inconvenient sometimes, but it doesn’t mean it should go ignored.

Maybe 10 or 20 years ago, it was enough for doctors to just tell women to avoid lifting heavy weights, because the idea of women picking up heavy things and putting them down for fitness purposes was still kind of exotic and foreign for a lot of us. Things have changed a lot since then. CrossFit is exploding in popularity, more women are trying out powerlifting and Olympic lifting, more trainers and fitness professionals are encouraging women to pick up dumbbells and barbells. Down here in Florida, girls’ weightlifting is an actual sport in high schools and it is picking up in popularity as time goes on. It seems like at least once a day I read a personal account from a woman who says lifting weights changed her life, not just physically but emotionally and psychologically, too.

The medical establishment’s understanding of the role of weightlifting in women’s lives needs to undergo an evolution in this regard. It’s no longer adequate to say that women shouldn’t lift heavy things and leave it at that. I doubt that few women who lift – myself included – would be all that enthused at the prospect of just giving up on something that is a source of pleasure and pride for us.

Instead, I’d rather see realistic research-based guidelines that take the fact that many women do like to lift weights into consideration when discussing the risks of prolapse. I’d like to see information that looks for a way for women to continue to lift heavy weights while reducing their risk instead of just telling us to stop lifting altogether.. But before those can be developed, the research has to actually happen first.

This brings me to my final point, which is that this provides a case study for the importance of diversity in research. Researchers are generally very skilled and imaginative when it comes to developing their plans, but even the most imaginative researcher is going to have limitations. This is not a slam on the researcher but rather a fact. I have to wonder how many male exercise scientists, for instance, are aware of the fact that uterine prolapse is even a thing, let alone that it could be exacerbated by squatting with heavy weights. (Shoot, I wonder how many female exercise scientists know this.)

I run into this in my own life as a journalist, where I am going to be limited in the stories I write by the information I have access to. If there is information out there that totally changes my narrative but I don’t find it while doing my reporting, then I have no way of knowing that I’m advancing an incomplete narrative. I do my best to overcome those shortcomings, but the shortcomings will always be there, which is why having several journalists from different backgrounds cover the same subject matter is a good way to ensure the territory is well-explored.

And it’s also a good case study for the importance of diversity when it comes to research subjects. For a long time, almost all medical research was performed on men, with the assumption that women’s bodies were just like men’s except smaller. The end result can be catastrophic. Here’s more information about the push for more inclusive clinical trials in medical research. Research that looks at the effect of a squat on a man’s body is not going to take into consideration possible pelvic organ issues faced by women, and research that looks only at younger women who have not had children will miss the potential risks faced by older women who have had children.

So. That’s a lot of words and a lot of thinking that results in no answers, just more questions. But hey, questions are a good place to start, right?

15 responses to “Untangling the relationship between weightlifting and uterine prolapse”

My guess would be that there is similar information out there about hernias. Some people seem to have genetic disposition to them, but they can happen to anyone, and like this, certain things can aggravate them. Your guidelines make sense to me, and honestly, could be used with a variety of injuries. Be smart, see a doctor, don’t panic, use good form, and in all likelihood, weights will help in the long run – not hurt.

I understand that some woman could have benefice from strenghtening pelvic floor to decrease problems in small pelvic in case of poor strenght in that region; i would not advise weight lifting to strenghten it up but I would avise to do this through body weight exercises;
If you increase inta)abominal pression there will always be strain on uterine ligaments and bladder; ; same thing with uhum defecation ; do not push ,! you strain tissu that is not able to ddefend itself because it has no contractive fibers.;
D.H. osteopathe

Awesome article! I’ve just started following your blog and I really loved that you linked back to the peer-reviewed sources. Despite that being the alleged standard for quality science-based writing, I really don’t think it’s done often enough.

I thought I’d share two more articles that I found that may interest you and other readers!

Hey, thanks, Jess! I will admit that I am not as rigorous about citing peer-reviewed sources when it comes to science writing, even though I know I should be, but I am trying to make an effort to become better about it.

Also, thank you for sharing those links – I will check them out once I get a chance.

I agree with that completely. I think that’s actually the fundamental difference between what some people advocate – no heavy lifting for women, period – and what I’m advocating – realistic guidelines that acknowledge the possibility of risk for certain women.

I used to work at a physical therapy clinic, and they had a women’s health practice as well – yep, PT for your pelvic floor! I learned a lot about all that stuff that I had no idea about. My number one takeaway was to strengthen your transverse abdominis and proper form always! One of the biggest problems is that pelvic/vaginal/sexual health are not really talked about and so women don’t always know that there are resources and that stress incontinence isn’t something “you just have to deal with after giving birth.” That having to go to the bathroom every hour, or pee a little when you sneeze is normal – it may be common, but it’s treatable. The director of the Women’s Health at that clinic started a website and movement to raise awareness and share information: http://sharemayflowers.org/index.htm

Particularly interesting to me is the section on the prevalence of SUI in young female athletes, but it’s all really interesting stuff that women should be aware of!

I wonder if any European studies, medical groups etc. have a stance on the best treatments/prevention — there was an article in Slate about postpartum treament “la rééducation périnéale. This is a kind of physical therapy designed to retrain the muscles of the pelvic floor, including the vagina, and is one of the cornerstones of French postnatal care. ”

It just seems odd that something so common would go un-studied – perhaps because it is not a problem elsewhere (just here?)

I actually read a bit about perineal/pelvic floor therapy that is considered part of postnatal care in France while doing research for this, and I think I may have even read that Slate article. I really don’t know why that isn’t more of a thing here in the States. I spent a year working for a women’s health clinic, and I gathered every bit of information that I could, and I never even heard about post-natal pelvic floor therapy until coming across it on the internet a couple of years back. It’s baffling to me how something that is evidently so effective can be so underutilized.

Would anyone happen to know any good cues on how to safely squat with the uterus in mind? I brace my abs and do the valsalva maneuver, (holding my breath), and aside from maintaining general squat form with low-bar, these are my main cues. I had a not-so-funny incident this past week after a run, the sensation of something slipping from my pelvic region. This did not happen on a day of squatting. I’ve only felt discomfort from it, and walked slower for a couple of days. I’ve been squatting for two years now with no incident, and I once had a tipped uterus, 9 years ago. Any more information would be greatly appreciated.

Good research. I’m commenting very late because there is one aspect you are missing (and how could you know, when you don’t :): I think there is serious issue especially with American knowledge on this issue. Which is why the legend may run freer in English texts.

Let me explain.

In many countries in Europe, including mine (Finland) pelvic floor exercises (without any actual devices) are advised to all women who have given birth. They are not assisted but are controlled with postnatal checkups (we have something like 6 of those in the first year after birth and many of the first ones are as much about the mother as the baby).
In some countries like France, there is actually free assisted pelvic floor exercises offered to all new moms.

Also the magazines & the like seem to be very up to this – every once in a while, you seen an article where the exercises are suggested to help in all of the issues mentioned in your post. Not that I’d ever had anyone hear talking about lifting to cause any of the damage – maybe in the context that it may make you pee but that’s not because of the lifting but because your pelvic muscles need, well, a lift.